Supraventricular tachycardia with atrial activation earliest at the His bundle region—What is the mechanism?

2019 ◽  
Vol 30 (11) ◽  
pp. 2535-2538
Author(s):  
Qiufan Chen ◽  
Qiang Liu ◽  
Chenyang Jiang

Author(s):  
Yasushi Wakabayashi ◽  
Takeshi Mitsuhashi ◽  
Shingo Yamamoto ◽  
Hideo Fujita ◽  
Shin‐ichi Momomura


Heart Rhythm ◽  
2021 ◽  
Vol 18 (1) ◽  
pp. 142-144
Author(s):  
Akira Mizukami ◽  
Mitsunori Maruyama ◽  
Akihiko Matsumura ◽  
Tetsuo Sasano


2000 ◽  
Vol 11 (5) ◽  
pp. 603-604
Author(s):  
TSE-MIN LU ◽  
CHING TAI TAI ◽  
CHIN-FENG TSAI ◽  
SHIH-ANN CHEN


2019 ◽  
Vol 42 (10) ◽  
pp. 1374-1382 ◽  
Author(s):  
Ahmed I. Elbatran ◽  
John K. Zarif ◽  
Mazen Tawfik


Heart Rhythm ◽  
2011 ◽  
Vol 8 (8) ◽  
pp. 1299-1301
Author(s):  
Sachin Nayyar ◽  
Vanita Arora ◽  
Mohan Nair


1995 ◽  
Vol 82 (6) ◽  
pp. 1447-1455.
Author(s):  
Harvey J. Woehlck ◽  
Martin N. Vicenzi ◽  
Jurica Bajic ◽  
Stephen M. Sokolyk ◽  
Zeljko J. Bosnjak ◽  
...  

Background Subsidiary atrial pacemakers assume control after sinoatrial (SA) node excision, and anesthetic-catecholamine interactions can produce severe bradycardia during isoflurane anesthesia. We hypothesized that epinephrine enhances atrial, atrioventricular junctional, and ventricular dysrhythmias after SA node excisions in dogs and that inhalation anesthetics would facilitate such dysrhythmias. Methods In eight dogs, SA nodes were excised and epicardial electrodes implanted at the atrial appendages, at the His bundle, and along the sulcus terminalis. Site of the earliest atrial activation and incidences of nonatrial beats were determined in the conscious state, with methylatropine, with epinephrine, and during halothane, isoflurane, or enflurane anesthesia. Results After SA node excision, a stable, regular subsidiary atrial pacemaker rhythm resulted. Epinephrine and halothane shifted the site of earliest activation to more remote atrial sites. Epinephrine-induced ventricular escape was increased by all anesthetics tested, but atropine prevented ventricular escape. Epinephrine-induced His bundle (atrioventricular junctional) and premature ventricular beats were increased by halothane and enflurane. After SA node excision, ventricular escape occurred as a result of epinephrine-anesthetic interactions, especially during anesthesia with isoflurane. Conclusions In dogs with excised SA nodes, anesthetic-catecholamine interaction facilitates ventricular escape, His bundle dysrhythmias, and premature ventricular beats. In addition, halothane and enflurane, more than isoflurane, facilitate ectopic ventricular tachydysrhythmias with epinephrine. Compared to intact dogs, dogs with excised SA nodes may be more susceptible to epinephrine anesthetic dysrhythmias. If findings can be extrapolated to humans, intrinsic SA node dysfunction may facilitate severe cardiac dysrhythmias with inhalation anesthetics and catecholamines.



2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Yoshiaki Kaneko ◽  
Tadashi Nakajima ◽  
Shuntaro Tamura ◽  
Hiroshi Hasegawa ◽  
Takashi Kobari ◽  
...  

Background: Superior-type fast-slow (sup-F/S-) atrioventricular nodal reentrant tachycardia (AVNRT) is a rare AVNRT variant using a superior slow pathway (SP) as the retrograde limb. Its intracardiac appearance, characterized by a short atrio-His (AH) interval and the earliest site of atrial activation in the His-bundle, is an initial indicator for making a diagnosis. Methods: Among 22 consecutive patients with sup-F/S-AVNRT, 3 (age, 68–81 years) patients had an apparent slow-fast (S/F-) AVNRT characterized by a long AH interval and the earliest site of atrial activation in or superior to the His-bundle region (tachy-long-AH). Results: The diagnosis of sup-F/S-AVNRT was based on the standard criteria in 2 patients and on the occurrence of Wenckebach-type atrioventricular block during tachycardia, which was attributable to a block at the lower common pathway (LCP) below the circuit of the AVNRT, detected owing to the lower common pathway potentials, in one patient. As with the typical S/F-AVNRT, tachy-long-AH was induced after a jump in the AH interval. In contrast to typical S/F-AVNRT, fluctuation in the ventriculoatrial interval was observed during the tachy-long-AH. Ventricular overdrive pacing was unable to entrain or terminate the tachy-long-AH. Moreover, the tachy-long-AH reciprocally transited to/from sup-F/S-AVNRT spontaneously or was triggered by ventricular contractions while the atrial cycle length and earliest site of atrial activation remained unchanged. Both tachycardias were cured by ablation at a single site in the right-side para-Hisian region of 2 patients and the noncoronary aortic cusp of one patient. Collectively, the essential circuit of both tachycardias was identical, and the tachy-long-AH was diagnosed as another phenotype of sup-F/S-AVNRT accompanied by sustained antegrade conduction via another bystander slow pathway breaking through the His-bundle owing to the repetitive antegrade block at the lower common pathway, thus representing a long AH interval during the ongoing sup-F/S-AVNRT. Conclusions: An unknown sup-F/S-AVNRT phenotype exists that apparently mimics the typical S/F-AVNRT and is also an unknown subtype of apparent S/F-AVNRT.



2020 ◽  
Vol 31 (9) ◽  
pp. 2516-2518
Author(s):  
Deep Chandh Raja ◽  
Krishna Kumar Mohanan Nair ◽  
Nitish Badhwar ◽  
Ulhas M. Pandurangi


2020 ◽  
Author(s):  
Deep Raja ◽  
Krishna Kumar Mohanan Nair ◽  
Nitish Badhwar ◽  
ULHAS PANDURANGI


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